{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:56:04Z","timestamp":1791939364948,"version":"4.3.4"},"reference-count":84,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service","award":["DK56338"],"award-info":[{"award-number":["DK56338"]}]},{"name":"Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service","award":["RP220127"],"award-info":[{"award-number":["RP220127"]}]},{"name":"Cancer Prevention and Research Institute of Texas","award":["DK56338"],"award-info":[{"award-number":["DK56338"]}]},{"name":"Cancer Prevention and Research Institute of Texas","award":["RP220127"],"award-info":[{"award-number":["RP220127"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology"],"abstract":"<jats:p>Helicobacter pylori is a class I carcinogen that infects more than 100 million individuals in the United States. Antimicrobial therapy for H. pylori has typically been prescribed empirically rather than based on susceptibility testing. Until recently, therapeutic recommendations have generally ignored the principles of antibiotic stewardship. A combination of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin (triple therapy) remains popular despite increasing clarithromycin resistance and poor cure rates. Concomitant therapy (a PPI, amoxicillin, clarithromycin, and metronidazole) is recommended and widely used despite all patients receiving at least one unneeded antibiotic. In 2020, the Food and Drug Administration approved vonoprazan, amoxicillin, and clarithromycin triple therapy, which administers unneeded clarithromycin to &gt;90% of patients (i.e., ~6 tons of unneeded clarithromycin\/million treatments). In the late 1980s, the infectious disease community functionally transferred responsibility for the management of H. pylori to gastroenterology, which has managed the infection as another common gastrointestinal disease such as constipation. In 2022, both traditional and noninvasive molecular-based susceptibility testing for H. pylori became available in the United States. In order to reduce and prevent antibiotic misuse, the infectious disease community should reclaim responsibility for the management of this important infectious disease.<\/jats:p>","DOI":"10.3390\/pharma3010006","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T06:50:22Z","timestamp":1708498222000},"page":"82-93","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Crises in Antimicrobial Stewardship: Misuse of Clarithromycin for Helicobacter pylori Therapy"],"prefix":"10.3390","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6908-8317","authenticated-orcid":false,"given":"David Y.","family":"Graham","sequence":"first","affiliation":[{"name":"Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine Houston, 2002 Holcombe Blvd (111D), Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/S2468-1253(23)00070-5","article-title":"Global prevalence of Helicobacter pylori infection between 1980 and 2022: A systematic review and meta-analysis","volume":"8","author":"Li","year":"2023","journal-title":"Lancet Gastroenterol. 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